• Mona Elsherbiny, Ahmed Hasanin, Sahar Kasem, Mohamed Abouzeid, Maha Mostafa, Ahmed Fouad, and Yaser Abdelwahab.
• Anesthesia and Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt.
• BMC Anesthesiol. 2023 Oct 3; 23 (1): 329329.

BackgroundWe aimed to compare the hemodynamic effect of two ratios of propofol and ketamine (ketofol), namely 1:1 and 1:3 ratios, in rapid-sequence induction of anesthesia for emergency laparotomy.MethodsThis randomized controlled study included adult patients undergoing emergency laparotomy under general anesthesia. The patients were randomized to receive either ketofol ratio of 1:1 (n = 37) or ketofol ratio of 1:3 (n = 37). Hypotension (mean arterial pressure < 70 mmHg) was managed by 5-mcg norepinephrine. The primary outcome was total norepinephrine requirements during the postinduction period. Secondary outcomes included the incidence of postinduction hypotension, and the intubation condition (excellent, good, or poor).ResultsThirty-seven patients in the ketofol-1:1 and 35 patients in the ketofol 1:3 group were analyzed. The total norepinephrine requirement was less in the ketofol-1:1 group than in the ketofol-1:3 group, P-values: 0.043. The incidence of postinduction hypotension was less in the ketofol-1:1 group (4 [12%]) than in ketofol-1:3 group (12 [35%]), P-value 0.022. All the included patients had excellent intubation condition.ConclusionIn patients undergoing emergency laparotomy, the use of ketofol in 1:1 ratio for rapid-sequence induction of anesthesia was associated with less incidence of postinduction hypotension and vasopressor consumption in comparison to the 1:3 ratio with comparable intubation conditions.Clinical Trial RegistrationNCT05166330. URL: https://clinicaltrials.gov/ct2/show/NCT05166330 .© 2023. BioMed Central Ltd., part of Springer Nature.

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